Dynamics of point defects and stripe textures in Smectic-C Langmuir monolayers.

Langmuir monolayers of an azobenzene fatty acid derivative have been studied experimentally in a regime where confined domains with Smectic-C order form spontaneously. Coalescence of domains results in a dynamics of formation and annihilation of point defects and string-like distortions of the molecular field amenable to semi-quantitative analysis. Absence of backflow and layer thickness effects enables us to extract values for material parameters from the analysis of defect dynamics.

[Diagnosis and prognosis of atheroembolic disease]. / Diagnóstico y pronóstico de la enfermedad ateroembólica.

Atheroembolic disease is recognized as an iatrogenic complication from an invasive vascular procedure, such as manipulation of the aorta during angiography or vascular surgery, and after anticoagulant and fibrinolytic therapy. Cholesterol crystal embolism is caused by showers of cholesterol crystals from an atherosclerotic aorta that occlude small arteries. The kidney is a frequent target organ for cholesterol emboli because of proximity of the renal arteries to abdominal aorta and it receive an enormous amount of blood flows. We describe the epidemiologic agents of 19 cases that were diagnosed by histologic sections of the affected tissues; the eosinophilia and the renal failure are the clinical features that guide to the diagnosis, in patients with ischemic nephropathy and general atherosclerosis. 53% among patients had a previous invasive procedure and 26% occurred spontaneously. We remark the importance of the kidney's biopsy in diagnosis of the atheroembolic disease and their bad prognosis with 63% of death rate in 18 months of average follow-up. We report patients with the multiple cholesterol emboli syndrome mimicking systemic vasculitis: they died by multivisceral acute failure. The subacute presentation of atheroembolic disease with progressive renal failure treated with hemodialysis is a sign of bad prognosis. The knowledge of the disease and their prevention are the better treatment.

Single vs. double dose of a proton pump inhibitor in triple therapy for Helicobacter pylori eradication: a meta-analysis.

BACKGROUND: Triple therapies combining a double dose of proton pump inhibitor plus two antibiotics are the standard treatment for Helicobacter pylori infection. Some reports suggest that the use of half the dose of proton pump inhibitor is equally effective. AIM: To compare the efficacy of a single vs. double dose of proton pump inhibitor in triple therapy. METHODS: We conducted a MEDLINE search. The search strategy included the words (pylori) AND (triple, PPI, proton pump, omeprazole, rabeprazole, pantoprazole, lansoprazole, clarithromycin, amoxicillin, amoxycillin or metronidazole). Abstracts of the articles obtained and papers presented at the European Helicobacter pylori Study Group and American Gastroenterological Association congresses from 1996 to 2001 were examined. Inclusion criteria were: (i) randomized studies with at least two branches of triple therapy including a proton pump inhibitor and two standard antibiotics; (ii) branches could differ only in terms of proton pump inhibitor dosage. A meta-analysis was conducted using conventional shareware (Review Manager 4.1). RESULTS: Thirteen studies met the inclusion criteria with a total of 2391 patients. Cure rates with double doses of proton pump inhibitor were higher in both the intention-to-treat analysis (83.9% vs. 77.7%; Peto odds ratio, 1.51; 95% confidence interval, 1.23-1.85; P < 0.01) and per protocol analysis (89% vs. 81%; Peto odds ratio, 1.96; 95% confidence interval, 1.55-2.47; P < 0.01). CONCLUSION: Triple therapies containing a single dose of proton pump inhibitor are less effective than those containing a standard double dose of proton pump inhibitor.

Meta-analysis: comparative efficacy of different proton-pump inhibitors in triple therapy for Helicobacter pylori eradication.

BACKGROUND: It is not known whether certain proton-pump inhibitors are more efficacious than others when used in triple therapy for Helicobacter pylori eradication. AIM: To compare the efficacy of different proton-pump inhibitors in triple therapy by performing a meta-analysis. METHODS: A MEDLINE search was performed. Abstracts of the European Helicobacter pylori Study Group and the American Gastroenterological Association congresses from 1996 to 2002 were also examined. Randomized studies with at least two branches of triple therapy that differed only in terms of type of proton-pump inhibitor were included in a meta-analysis using Review Manager 4.1. RESULTS: Fourteen studies were included. Intention-to-treat cure rates were similar for omeprazole and lansoprazole: 74.7% vs. 76%, odds ratio (OR) 0.91 [95% confidence interval (CI) 0.69-1.21] in a total of 1085 patients; for omeprazole and rabeprazole: 77.9% vs. 81.2%, OR 0.81 (95% CI 0.58-1.15) in a total of 825 patients; for omeprazole and esomeprazole: 87.7% vs. 89%, OR 0.89 (95% CI 0.58-1.35) in 833 patients; and for lansoprazole and rabeprazole: 81% vs. 85.7%, OR 0.77 (95% CI 0.48-1.22) in 550 patients. CONCLUSION: The efficacy of various proton-pump inhibitors seems to be similar when used for H. pylori eradication in standard triple therapy.

[Primary antiphospholipid syndrome associated with malignant hypertension]. / Síndrome antifosfolipídico primario e HTA maligna.

The antiphospholipid syndrome is defined by the presence of antiphospholipid antibodies and recurrent thrombosis, affecting the venous system more frequently than the arterial one. Renal involvement is only observed in approximately 20-25% of cases, main renal artery thrombosis has been exceptionally described. We report a 39-year-old woman with previous history of recurrent thrombosis diagnosed as primary antiphospholipid syndrome, who presented malignant hypertension in the context of a renal artery thrombosis. She had a high IgG anticardiolipin antibody titre and positive lupus anticoagulant. An isotopic renogram demonstrated asymmetrical activity (60% right vs 40% left kidney). Renal arteriography demonstrated preoclusive thrombosis in the left renal artery. Blood pressure was well controlled by the use of ACE-inhibitor and alpha blockers.

Comparación de hemodiafiltración “mid-dilucional” respecto a hemodiafiltración pre y postdilucional / Comparison of “mid-dilution” haemodiafiltration with pre- and post-dilution haemodiafiltration

La hemodiafiltración permite varias alternativas según se incorpore el líquido de reinfusión: pre-dilucional (antes del dializador), post-dilucional (después del dializador) y mixta (pre y post-dilución). Una alternativa a esta última es un dializador diseñado para realizar la mid-dilución, dónde la sangre entra por un haz de fibras centrales y regresa, en sentido contrario, por fibras periféricas. El líquido de reinfusión se incorpora en la mitad de los dos tramos del dializador, así en el primer tramo se produce una hemodiafiltración post-dilucional y en el segundo tramo una hemodiafiltración pre-dilucional. El objetivo de este estudio fue comparar el modo de infusión mid-dilucional con los modos pre y post-dilucional, evaluando la depuración de varias moléculas de diferente peso molecular. Cada paciente fue sometido a tres sesiones de diálisis con una técnica diferente cada vez, respetando las características de la diálisis a excepción del volumen de infusión. La hemodiafiltración on-line con el modo de infusión mid-dilucional parece ser una buena alternativa que permite altos volúmenes convectivos con una mayor depuración de β2-microglobulina, prolactina, mioglobina y proteína transportadora de retinol en comparación con el modo postdilucional, y más llamativa en comparación con la hemodiafiltración predilucional (AU)

Various alternative forms of haemodia filtration are possible depending on when the reinfusion liquid isincorporated: pre-dilution (before the dialyser), postdilution (after the dialyser) and mixed (pre- and post-dilution). An alternative to the latter is a dialyser designed for mid-dilution, where the blood passes through a membrane of central fibres and returns, in the opposite direction, through peripheral fibres. The reinfusion liquid is incorporated in half of the two sections of the dialyser. Thus, in the first section post-dilution haemodia filtration takes place, and in the second section, pre-dilution haemodiafltration. The aim of this study was to compare the forms of mid-dilution infusion with pre- and post-dilution, evaluating the removal of various molecules with different molecular weight. Each patient underwent three dialysis sessions, using a different technique each time, respecting the characteristics of the dialysis except for the infusion volume. Mid-dilution on-line haemodiafiltration seems to a be a good alternative that permits high convective volumes with a greater purification of β2-microglobulin,prolactin, myoglobin and retinol binding protein compared to post-dilution haemodiafiltration, and more marked compared to pre-dilution haemodiafiltration (AU)

Diagnóstico y pronóstico de la enfermedad ateroembólica / Diagnosis and prognosis of atheroembolic disease

La enfermedad ateroembólica suele desencadenarse a partir de técnicas diagnósticasy terapéuticas vasculares invasivas, o a partir del tratamiento con anticoagulanteso fibrinolíticos. Se caracteriza por la oclusión de arteriolas desde placasateromatosas, con componente de colesterol, liberadas en general desde la aorta.El riñón es probablemente el órgano que más se afecta por su localización próximaa la aorta abdominal, y por la cantidad de flujo sanguíneo que recibe.Describimos los factores epidemiológicos de 19 casos diagnosticados por criterioshistológicos en 18 de ellos, resaltando la eosinofilia y la insuficiencia renalprogresiva como datos clínicos orientativos de la enfermedad, en pacientes connefropatía isquémica y arteriosclerosis generalizada. Un 53% de los pacientes sepresentan con el antecedente de cateterismo o maniobra quirúrgica vascular; un26% de manera totalmente espontánea.Resaltamos la importancia de la biopsia renal en el diagnóstico de la enfermedadateroembólica, y su mal pronóstico general con una mortalidad del 63% enun seguimiento medio de 18 meses. Resaltamos el fallo multiorgánico como causade fallecimiento en los pacientes que se presentan con formas similares a una vasculitissistémica. Y resaltamos la insuficiencia renal con requerimiento de diálisis,como índice de mal pronóstico en los enfermos que se presentan de forma subaguda.El conocimiento de la enfermedad y su prevención resultan las terapéuticasmás eficaces

Atheroembolic disease is recognized as an iatrogenic complication from an invasivevascular procedure, such as manipulation of the aorta during angiographyor vascular surgery, and after anticoagulant and fibrinolytic therapy. Cholesterolcrystal embolism is caused by showers of cholesterol crystals from an atheroscleroticaorta that occlude small arteries. The kidney is a frequent target organ for cholesterol emboli because of proximity of the renal arteries to abdominal aortaand it receive an enormous amount of blood flows.We describe the epidemiologic agents of 19 cases that were diagnosed by histologicsections of the affected tissues; the eosinophilia and the renal failure arethe clinical features that guide to the diagnosis, in patients with ischemic nephropathyand general atherosclerosis. 53% among patients had a previous invasiveprocedure and 26% occurred spontaneously.We remark the importance of the kidney’s biopsy in diagnosis of the atheroembolicdisease and their bad prognosis with 63% of death rate in 18 months ofaverage follow-up. We report patients with the multiple cholesterol emboli syndromemimicking systemic vasculitis: they died by multivisceral acute failure. Thesubacute presentation of atheroembolic disease with progressive renal failure treatedwith hemodialysis is a sign of bad prognosis. The knowledge of the diseaseand their prevention are the better treatment

Síndrome antifosfolipídico primario e HTA maligna / Antiphospholipid síndrome associated to malignat hypertension

El síndrome antifosfolipídico viene definido por la presencia de anticuerpos antifosfolípidos y trombosis de repetición, siendo más prevalentes las trombosis venosas que las arteriales. La afectación renal en el síndrome antifosfolipídico primario es poco frecuente, oscilando entre un 20-25% de los casos y siendo la trombosis de la arteria renal principal un acontecimiento raramente descrito. Presentamos el caso de una mujer de 39 años, con historia previa de trombosis de repetición y diagnosticada de síndrome antifosfolipídico primario, que desarrolló hipertensión arterial maligna en el contexto de una oclusión de la arteria renal. Presentaba anticuerpos anticardiolipina IgG positivos a títulos elevados, anticoagulante lúpico positivo. El renograma isotópico objetivó una asimetría en la captación renal (60% a nivel del riñón derecho y un 40% a nivel del riñón izquierdo). La arteriografía renal detectó una trombosis pre-oclusiva de la arteria renal izquierda. Se consiguió un control óptimo de la presión arterial mediante el tratamiento con inhibidores de la ECA y alfa-bloqueantes (AU)

The antiphospholipid syndrome is defined by the presence of antiphospholipid antibodies and recurrent thrombosis, affecting the venous system more frequently than the arterial one. Renal involvement is only observed in approximatelly 20- 25% of cases, main renal artery thrombosis has been exceptionally described. We report a 39 year old woman with previous history of recurrent thrombosis diagnosed as primary antiphospholipid syndrome, who presented malignant hypertension in the context of a renal artery thrombosis. She had a high IgG anticardiolipin antibodies title and positive lupic anticoagulant. An isotopic renogram demonstrated assymetrical activity (60% right vs 40% left kidney). Renal arteriography demonstrated preoclusive thrombosis in the left renal artery. Blood pressure was well controlled by the use of ACE-inhibitor and alfablockers (AU)